Emergency Medical Services (EMS) is frequently called in cases of drug overdose or withdrawal.
When an ambulance responds to a 911 call for an overdose, paramedics administer treatment to prevent the patient from dying but do not provide medication to address the underlying addiction. This is a critical missed opportunity because patients treated for a non-fatal overdose are at a greater risk of dying within the next year.
We engage EMS in the treatment of Opioid Use Disorder
To save lives and improve patient outcomes, we engage EMS agencies and personnel in the treatment of opioid use disorder (OUD) and the prevention of opioid overdose. Under our EMS Bridge model, eligible patients are treated with buprenorphine from the ambulance. Paramedics use motivational interviewing to engage patients and encourage them to be seen at a nearby Emergency Department that treats OUD. All patients receive follow-up from a patient navigator who connects them to ongoing substance use disorder care. Paramedics also distribute naloxone to patients and their friends and family to prevent future overdose deaths.
EMS play a crucial role in overdose prevention.
Drug overdose deaths remain at an all-time high, and it is clear that we need a new approach to substance use. As the mobile medical providers who respond to overdoses, Emergency Medical Services (EMS) can play a critical role in helping high-risk patients get treatment for opioid use disorder (OUD) and using harm reduction measures to prevent future overdoses.
A missed opportunity to save more lives.
EMS is regularly called to respond to overdoses. While paramedics are trained to reverse an overdose, there has been no standard of care for treating OUD or preventing future overdose deaths. Commonly after a 911 response, patient information is held within the ambulance operator’s medical record. Although some patients are transported to Emergency Departments by ambulance, many refuse transport and therefore receive no effective follow-up services. This is a critical missed opportunity because research has found a 5.5% one-year mortality rate in patients discharged from the Emergency Department after a non-fatal opioid overdose. Of those who died in the first month after discharge, close to 5% died within the first 48 hours. Overdose survivors who decline EMS transport are at an even higher risk.
Over
5.5%
one-year mortality rate in patients discharged from the Emergency Department after a non-fatal opioid overdose.
EMS advances access to care.
Our work emphasizes treating people who use drugs equitably, no matter where they present in the healthcare system, by acknowledging that overdose is the acute complication of a chronic medical disease that should be treated as a medical emergency. For EMS, not offering a patient with myocardial infarction follow-up treatment would be unthinkable, yet for survivors of opioid overdose, not offering treatment is sadly the norm. People who use drugs are often mistrustful of the hospital system due to encounters in which they are demonized for having a substance use disorder. These negative experiences and fear of law enforcement make many people who use drugs reluctant to call 911 and accept transport to the hospital after an overdose.
Our work extends OUD treatment to EMS and reduces the stigma that makes many people who use drugs mistrust the system. We are bringing EMS into an integrated system of “no wrong door” access to care to advance equity and health outcomes for people with OUD in California.
Picture This
Typical Scenario
The Narcan the medics administer saves the patient’s life but then pushes the patient into painful withdrawal that can include excruciating pain, vomiting, and confusion. Not surprisingly, the patient is uncooperative and resistant.
The EMS staff responds with judgmental scolding, and the interaction descends into conflict.
This scene happens daily across the United States, but we are changing it.
VS.
EMS Bridge System
When the patient is revived, the staff treats them with buprenorphine which quickly relieves withdrawal symptoms. They can then engage the patient in non-judgmental, supportive, motivational interviewing and offer treatment options. Having had a positive interaction, the patient is more likely to engage in follow-up care.
A week later, a patient navigator contacts the medic and reports that the patient has received follow-up care and is grateful for the care provided by EMS. Through training and empowerment, the medic has been recruited into a system-wide community of caregivers helping people with OUD. Having personally experienced the reward of helping a person in need, with every call or every drop off at an ER, the EMS medic becomes a potential change agent promoting a non-discriminatory approach to OUD.
Past EMS Bridge Impact Reports
We provide resources to help EMS agencies launch programs to prevent overdose and treat OUD.
Featured Resource: Buprenorphine Field Start Protocol
Research has demonstrated that treating OUD with buprenorphine decreases the time a person is in opioid withdrawal pain and lowers their risk of future opioid overdose.
Local EMS agencies can use our Buprenorphine Field Start Protocol to make buprenorphine part of their local scope of practice.
EMS Buprenorphine Training Videos for Paramedics, ED Providers, and Base Physicians
Additional EMS Bridge Resources By Topic
Naloxone distribution is one of the easiest steps an EMS agency can take to prevent overdose. The following tools can help EMS agencies implement this program:
Treatment of OUD with buprenorphine (bup) has been demonstrated to reduce relapse and overdose. Starting bup in the field during a 911 call is a further innovation that can potentially bring more patients into care at a critical moment. Local EMS agencies can now make buprenorphine part of their local scope of practice. After obtaining approval, agencies can start with these tools:
EMS personnel encounter many people who use drugs, and these interactions can be challenging. By learning the techniques of “motivational interviewing,” first responders can greatly improve their effectiveness in turning these interactions into positive opportunities to build trust, practice harm reduction, and, in some cases, engage patients in treatment. Download this Motivational Interviewing Techniques Training.
Emergency Medical Services Buprenorphine Use Pilot Program (EMSBUP)
The EMSBUP program will support Local EMS Agencies (LEMSAs) and Emergency Medical Service (EMS) providers to provide treatment and access points for patients with opioid use disorder (OUD). EMS agencies participating in the EMSBUP program will address substance use disorder (SUD) as a treatable emergency condition, utilizing paramedics to identify and treat patients who would benefit from medication-assisted treatment (MAT).
- Assist prehospital agencies in implementing EMSBUP.
- Coordinate with navigators to provide linkage to care.
- Evaluate the effectiveness of the EMSBUP treatment model by collecting de-identified data for the Bridge Patient Outcomes research study and monthly performance metrics.
- Identify linkage to care options for EMS patients with an OUD and provide a system for patients who sign out AMA (against medical advice) to access outpatient treatment options. PHI/Bridge will provide all participating LEMSAs with access to materials, training, and technical assistance for navigators, clinicians, nurses, and other hospital staff and stakeholders.
Application
The application period for the current RFA closed on July 1, 2025, at 11:59 PM PT. We are no longer accepting applications.
Data Reporting Overview
Local EMS Agencies (LEMSAs) receiving funding from EMS Bridge for the EMS Buprenorphine Use Pilot program will submit monthly data through the data portal by the 10th of each month for the duration of the contract period.
Please review the EMSBUP Data Reporting Overview before submitting your form.
Bridge Center Announces Two Funding Recipients to Implement Buprenorphine Protocol in the Prehospital Setting
The Bridge Center, a program of the Public Health Institute, will be awarding two additional $400,000 grants to the Local Emergency Medical Services Agencies (LEMSAs) of Alameda and Sacramento Counties to implement an innovative EMS-based buprenorphine pilot project. The Stanislaus County LEMSA was awarded a $400,000 grant earlier this year. This funding is made possible through State Opioid Response IV funding from the California Department of Health Care Services (DHCS), which supports the LEMSAs’ efforts to expand access to evidence-based treatment for opioid use disorder (OUD) by integrating buprenorphine administration with the emergency medical services (EMS) response.
Through this project, Stanislaus, Alameda, and Sacramento LEMSAs will train paramedics to initiate buprenorphine treatment for patients experiencing acute opioid withdrawal and connect them to ongoing care. This initiative aligns with California’s broader harm reduction and treatment expansion objectives, emphasizing community-response solutions to the opioid crisis.
For more information about EMS-based buprenorphine pilot program, please contact Vanessa Lara, EMS Bridge Project Manager, at vlara@bridgetotreatment.org.
Publications
Characteristics of Patients Experiencing Opioid Overdose and Eligibility for Prehospital Treatment with Buprenorphine
Hern, H. G., Lara, V., Cantwell-Frank, D., Abusaa, S., Rosen, A. D., & Herring, A. A. (2025). Prehospital Emergency Care, 1–8. doi.org/10.1080/10903127.2024.2445075
Prehospital initiation of buprenorphine treatment for opioid use disorder by paramedics
Hern HG, Goldstein D, Kalmin M, et al. Prehospital Emergency Care. 2021;26(6):811-817. doi:10.1080/10903127.2021.1977440
Prehospital buprenorphine treatment for opioid use disorder by paramedics: First year results of the EMS Buprenorphine Use Pilot
Hern HG, Lara V, Goldstein D, et al. Prehospital Emergency Care. 2022;27(3):334-342. doi:10.1080/10903127.2022.2061661
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